What is the first and last name of the child who will be attending Camp Super Hero?

You'll have the option of enrolling additional kids later in this form.

OK

press ENTER

Thanks {{answer_iILVLfDdsIWC}}! Next we need to know how to reach you. What is your phone number?

OK

press ENTER

Email address?

OK

press ENTER

Street address?

OK

press ENTER

City?

OK

press ENTER

Zip code?

OK

press ENTER

Ok, back to the fun stuff. We can't wait to meet {{answer_gVvL748d2LKh}}. Where does your Super Hero go to school?

OK

press ENTER

What grade will {{answer_gVvL748d2LKh}} start in the fall of 2018?

Choose as many as you like

A

5th

B

6th

C

7th

D

8th

OK

press ENTER

Which dates will {{answer_gVvL748d2LKh}} attend Camp?

The cost is $10 per day.

Choose as many as you like

A

July 11

B

August 1

C

August 8

OK

press ENTER

Does {{answer_gVvL748d2LKh}} have any allergies?

Choose as many as you like

A

Yes

B

No

OK

press ENTER

Please list allergies below & describe reaction. What is the treatment for this reaction?

OK

press ENTER

Are there any past or present health concerns that we should be aware of (surgical, developmental, behavioral, psychological, etc.)

Press enter to skip.

OK

press ENTER

Is your child on any medication that will be required to be taken at camp?

Choose as many as you like

A

No

B

Yes

OK

press ENTER

Please provide instruction on how to Volunteer Center staff should administer medication.

OK

press ENTER

We just need a little more information about your Super Hero. What size T-shirt does {{answer_gVvL748d2LKh}} wear?

Shirts are unisex and available in adult sizes only.

Choose as many as you like

A

S

B

M

C

L

D

XL

E

XXL

OK

press ENTER

Do you have another middle-school-aged child you would like to register for Camp Super Hero?

Choose as many as you like

A

Yes

B

No

OK

press ENTER

What is the first and last name of the second child who will be attending Camp Super Hero?

OK

press ENTER

Where does {{answer_aEXTB71IUYzM}} go to school?

OK

press ENTER

What grade will {{answer_aEXTB71IUYzM}} start in the fall of 2018?

Choose as many as you like

A

5th

B

6th

C

7th

D

8th

OK

press ENTER

Which dates will {{answer_aEXTB71IUYzM}} attend Camp?

Cost is $10 per day.

Choose as many as you like

A

July 11

B

August 1

C

August 8

OK

press ENTER

Does {{answer_aEXTB71IUYzM}} have any allergies?

Choose as many as you like

A

Yes

B

No

OK

press ENTER

Please list allergies below & describe reaction. What is the treatment for this reaction?

OK

press ENTER

Are there any past or present health concerns that we should be aware of (surgical, developmental, behavioral, psychological, etc.)

Press enter to skip.

OK

press ENTER

Is your child on any medication that will be required to be taken at camp?

Choose as many as you like

A

No

B

Yes

OK

press ENTER

Please provide instruction on how to Volunteer Center staff should administer medication.

OK

press ENTER

We just need a little more information about your Super Hero. What size T-shirt does {{answer_aEXTB71IUYzM}} wear?

Shirts are unisex and available in adult sizes only.

Choose as many as you like

A

S

B

M

C

L

D

XL

E

XXL

OK

press ENTER

Do you have a third middle-school-aged child you would like to register for Camp Super Hero?

Choose as many as you like

A

Yes

B

No

OK

press ENTER

What is the first and last name of the third child who will be attending Camp Super Hero?

OK

press ENTER

Where does {{answer_wNENpm7FfIE1}} go to school?

OK

press ENTER

What grade will {{answer_wNENpm7FfIE1}} start in the fall of 2018?

Choose as many as you like

A

5th

B

6th

C

7th

D

8th

OK

press ENTER

Which dates will {{answer_wNENpm7FfIE1}} attend Camp?

Cost is $10 per day.

Choose as many as you like

A

July 11

B

August 1

C

August 8

OK

press ENTER

Does {{answer_wNENpm7FfIE1}} have any allergies?

Choose as many as you like

A

Yes

B

No

OK

press ENTER

Please list allergies below & describe reaction. What is the treatment for this reaction?

OK

press ENTER

Are there any past or present health concerns that we should be aware of (surgical, developmental, behavioral, psychological, etc.)

Press enter to skip.

OK

press ENTER

Is your child on any medication that will be required to be taken at camp?

Choose as many as you like

A

No

B

Yes

OK

press ENTER

Please provide instruction on how to Volunteer Center staff should administer medication.

OK

press ENTER

We just need a little more information about your Super Hero. What size T-shirt does {{answer_wNENpm7FfIE1}} wear?

Shirts are unisex and available in adult sizes only.

Choose as many as you like

A

S

B

M

C

L

D

XL

E

XXL

OK

press ENTER

We are planning on driving the Do Good Bus in the July 4th parade in West Bend. Would your child(ren) be available to ride in the parade with us?

The time frame will likely be 8:45 a.m. - 10:30 a.m. The parade starts at 9:30 a.m. and runs from Badger Middle School to Regner Park.

Choose as many as you like

A

Yes

B

No

OK

press ENTER

We would always try to reach you first in the event of an emergency. However, who else can we call if we cannot reach you?

Please include first & last name, relationship, and phone number.

SHIFT + ENTER to make a line break

OK

press ENTER

Parents must agree to all terms in the waiver below before the child(ren) can attend camp. Please read carefully before accepting.

I understand that Camp Super Hero is being conducted by the Volunteer Center of Washington County, and that while attending Camp Super Hero, my child will participate in programs and activities offered by the Volunteer Center and its partner nonprofit agencies.

I understand that accidents and injuries may occur during participation in such activities, and that every reasonable effort will be made to provide reasonable care by the camp staff.

I hereby give permission for my child to attend Camp Super Hero and to fully participate in all camp programs and activities.

I hereby give permission for medical attention to be administered to my child by the camp staff in the event of a medical emergency. When I cannot be contacted, I hereby give my consent to have my child transported to a hospital emergency room, and the hospital medical staff has my authorization to provide any treatment, at my expense, that a physician deems necessary for the well-being of my child.

In exchange for the services provided my child at Camp Super Hero, I hereby waive, release and hold harmless the Volunteer Center of Washington County and its board members, employees, volunteers and nonprofit partners from and against any and all present and future claims, costs, liabilities, expenses, or judgments, including attorney’s fees and court costs, resulting from any damage, loss, personal injury or illness to my child and/or damage to my child’s property arising from or out of my child’s attendance or enrollment in, or out of my child’s participation in activities at our offered by the Volunteer Center and whether or not arising in whole or in part from any act or omission of the parties above released.

Media: The Volunteer Center of Washington County has permission to use photographs and/or video of my child for promotional purposes.

Dismissal of Camper: The Volunteer Center of Washington County reserves the right to dismiss, in its sole discretion, any camper whose behavior is deemed unsatisfactory or detrimental to the best interests of Camp Super Hero, other campers and/or staff, in which case no refunds will be made.

I HAVE READ AND FULLY UNDERSTAND ALL THE TERMS AND CONDITIONS AS EXPLAINED ON THIS PARENTAL CONSENT FORM AND GIVE PERMISSION AS OUTLINED ABOVE.

I understand that Camp Super Hero is being conducted by the Volunteer Center of Washington County, and that while attending Camp Super Hero, my child will participate in programs and activities offered by the Volunteer Center and its partner nonprofit agencies.

I understand that accidents and injuries may occur during participation in such activities, and that every reasonable effort will be made to provide reasonable care by the camp staff.

I hereby give permission for my child to attend Camp Super Hero and to fully participate in all camp programs and activities.

I hereby give permission for medical attention to be administered to my child by the camp staff in the event of a medical emergency. When I cannot be contacted, I hereby give my consent to have my child transported to a hospital emergency room, and the hospital medical staff has my authorization to provide any treatment, at my expense, that a physician deems necessary for the well-being of my child.

In exchange for the services provided my child at Camp Super Hero, I hereby waive, release and hold harmless the Volunteer Center of Washington County and its board members, employees, volunteers and nonprofit partners from and against any and all present and future claims, costs, liabilities, expenses, or judgments, including attorney’s fees and court costs, resulting from any damage, loss, personal injury or illness to my child and/or damage to my child’s property arising from or out of my child’s attendance or enrollment in, or out of my child’s participation in activities at our offered by the Volunteer Center and whether or not arising in whole or in part from any act or omission of the parties above released.

Media: The Volunteer Center of Washington County has permission to use photographs and/or video of my child for promotional purposes.

Dismissal of Camper: The Volunteer Center of Washington County reserves the right to dismiss, in its sole discretion, any camper whose behavior is deemed unsatisfactory or detrimental to the best interests of Camp Super Hero, other campers and/or staff, in which case no refunds will be made.

I HAVE READ AND FULLY UNDERSTAND ALL THE TERMS AND CONDITIONS AS EXPLAINED ON THIS PARENTAL CONSENT FORM AND GIVE PERMISSION AS OUTLINED ABOVE.